- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,078.28 / $1,355.09 / $1,858.04
| Professional | | $1,078.28 | $1,355.09 | $1,858.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,046.92 / $1,705.97 / $2,863.06
| Professional | | $1,046.92 | $1,705.97 | $2,863.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.59 / $1,369.17 / $1,689.84
| Professional | | $684.59 | $1,369.17 | $1,689.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.97 / $1,052.02 / $1,836.51
| Professional | | $144.97 | $1,052.02 | $1,836.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.07 / $1,621.20 / $2,799.31
| Professional | | $1,138.07 | $1,621.20 | $2,799.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.15 / $1,125.47 / $1,125.47
| Professional | | $870.15 | $1,125.47 | $1,125.47 |